Left Atrial Appendage Occlusion: What Are the Options and Where is the Evidence?

Chava, Raghuram; Turagam, Mohit K.; Lakkireddy, Dhanunjaya

doi:10.19102/icrm.2018.090402

Cited by 4 publications

(5 citation statements)

References 71 publications

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“…A 3D LA fibrosis map was created using volume rendering module in Corview software (Marrek Inc., Salt Lake City, UT). Inter-observer and intra-observer reproducibility for this technique was previously reported (17). Fibrosis was represented as the volumetric percentage of left atrial wall enhancement.…”

Section: La Fibrosis Assessmentmentioning

confidence: 96%

“…The left atrial appendage (LAA) is the most common source for the formation of systemic thromboemboli due to its unique shape and increased tendency for blood stasis (14).The entrance from the LA into the LAA is the LAA ostium, which is usually defined by the coumadin ridge superiorly and the left circumflex artery inferiorly (15). The LAA ostium was initially studied and measured for developing techniques for LAA occlusion (16), such as the use of ligation, clip or a Watchman device (17). However, detailed evidence is lacking on how baseline LAA ostium characteristics are correlated with other anatomical and clinical parameters of the LA and LAA in AF patients.…”

mentioning

confidence: 99%

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Left Atrial Appendage Remodeling after Atrial Fibrillation Ablation

Zhang

Hajjar

Chao

et al. 2022

Preprint

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Introduction: Larger left atrial appendage (LAA) ostium area and greater left atrial (LA) volume have been associated with an increased risk of ischemic stroke. Catheter ablation (CA) of atrial fibrillation (AF) leads to morphological and functional changes within the LA and LAA, some of which are not well studied. Here, we present findings regarding post-ablation changes of the LAA ostia and correlate them with various LA, LAA and left ventricular (LV) functional and morphological metrics. Methods: This retrospective analysis included patients scheduled to undergo first-time radiofrequency CA for AF. Catheter ablation techniques included PVI with or without additional ablations. Cardiac magnetic resonance imaging (CMR) was used to assess LA, LAA and LV morphology and function, including LAA ostium area, LA/LAA volume and volume index, LA ejection fraction, LA strain, and LV ejection fraction. A Kruskal-Wallis test was used for correlating LAA ostial dimensions with other LA morphological and functional metrics. The t-test or two-sample Wilcoxon test were used to compare LA and LAA morphological parameters. Results: A total of 101 patients with AF were included in this study. The mean age was 60.1 ± 11.1 years, 69% were male, the average BMI was 29.22 ± 5.08. The LAA ostial area reduced significantly from 3.84 ± 1.15 cm before ablation to 3.42 ± 0.96 cm after ablation (p=0.0004). This reduction was asymmetrical, as the minor axis length decreased from 1.92 cm to 1.77 cm without significant changes in the major axis. LVEF increased from a pre-ablation average of 48.26% to a post-ablation average of 53.62% (p=0.015). Correlation of pre-ablation LVEF and LAA ostium area showed a near-significant negative trend (r=-0.21, p=0.083). LAEF correlated negatively with LAA ostial area (r=-0.289, p=0.0057), total LA strain (r=-0.248, p=0.0185), and passive LA strain (r=-0.208, p=0.049). Conclusion: There is a significant asymmetrical reduction of the LAA ostial area after AF ablation that is independent of LVEF changes. Larger LAA ostial area was associated with lower LAEF and LA strain. Remodeling of the LAA after AF ablation may help account for reduced risk of stroke and increased cardiac function.

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Section: La Fibrosis Assessmentmentioning

confidence: 96%

mentioning

confidence: 99%

Left Atrial Appendage Remodeling after Atrial Fibrillation Ablation

Zhang

Hajjar

Chao

et al. 2022

Preprint

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“…To this effect, Chava et al 3 share their perspective on the utility of mechanical devices as an alternative for stroke protection in carefully selected patients.…”

Section: In This Issue Of the Journal Of Innovations In Cardiac Rhythmmentioning

confidence: 99%

Stroke Prevention in Patients with Atrial Fibrillation

Kowey¹

2018

J Innov Cardiac Rhythm Manage

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“…[14] Therefore, left atrial appendage occlusion (LAAO) has become a key mechanical intervention to prevent AF-related clots, especially for those at high bleeding risk or intolerant to oral anticoagulants (OACs). [15][16][17] LAAO patients may need less or no OACs, potentially requiring only single antiplatelet therapy. It effectively prevents strokes and minimizes bleeding more than OACs, making it suitable for patients with contraindications to OACs, recurrent bleeding, or previous brain hemorrhages.…”

Section: Introductionmentioning

confidence: 99%

Impact of chronic kidney disease on left atrial appendage occlusion: A meta-analysis of procedural outcomes and complications

Lee,

Chang,

Shih

et al. 2024

Medicine

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Background: Patients with chronic kidney disease (CKD) experience atrial fibrillation more frequently. The balance of medical management for stroke prevention and bleeding events presents a challenging issue in CKD population. Left atrial appendage occlusion (LAAO) may be an effective solution for stroke prevention in patients who experience frequent bleeding with oral anticoagulants. However, the specific impact of CKD on the procedural success, complications, and outcomes of LAAO implantations remains underexplored. Methods: We conducted a search of various databases for articles published before October 31, 2023. This search yielded 7 studies, comparing outcomes between CKD and non-CKD cohorts undergoing LAAO implantation. Our analysis focused on CHA2DS2-VASc scores, average eGFR, use of oral anticoagulants, procedural success rates, procedural complications, and associated outcomes. Results: The meta-analysis included data from 2576 patients, with 1131 identified as having CKD. The CKD group also had higher CHA2DS2-VASc scores (4.7 ± 1.4 vs 4.0 ± 1.5; P < .001) and HAS-BLED scores (3.8 ± 1.1 vs 3.1 ± 1.0; P < .001) than the non-CKD group. CKD patients showed a nonreduction in procedural success rates and a nonsignificant increase in total complications. The risks of stroke and transient ischemic attack, major bleeding, and cardiovascular mortality were not significantly different between the 2 groups. However, a significantly lower rate of total mortality was observed in the non-CKD group (odds ratio: 0.43; 95% confidence interval, 0.32–0.60). Conclusion: While CKD is associated with a nonsignificant decrease in procedural success and a nonsignificant increase in complication risks, the outcomes of LAAO implantation are comparably favorable between CKD and non-CKD groups. Despite similar procedural outcomes, the CKD group exhibited a higher rate of all-cause mortality.

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Left Atrial Appendage Occlusion: What Are the Options and Where is the Evidence?

Abstract: ABSTRACT. Left atrial appendage occlusion (LAAO) has emerged as an effective site-directed therapy in patients with nonvalvular atrial fibrillation (AF

Cited by 4 publications

References 71 publications

Left Atrial Appendage Remodeling after Atrial Fibrillation Ablation

Left Atrial Appendage Remodeling after Atrial Fibrillation Ablation

Stroke Prevention in Patients with Atrial Fibrillation

Impact of chronic kidney disease on left atrial appendage occlusion: A meta-analysis of procedural outcomes and complications

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